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Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Back in 2010, a group of primary care doctors from three different healthcare organizations across the US came together to launch a project in which they’d begin sharing their clinical notes directly with their patients. The doctors involved were part of a 12-month study designed to explore how such sharing would affect healthcare. The project was a success, and today, 10 million patients have access to their clinicians’ notes via OpenNotes.

Now, Rush University Medical Center has joined the party. The 664-bed academic hospital, which is based in Chicago, now allows patients to see all of their doctor’s notes through a secure web link which is part of Epic’s MyChart portal. According to Internet Health Management, Rush has been piloting OpenNotes since February and rolled it out across the system last month. Patients could already use MyChart to review physician instructions, prescriptions and test orders online.

If past research is any indication, the new service is likely to be hit with patients. According to a study from a few years ago, which looked at 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center, 99% of study participants wanted continued access to clinician notes after having it for one year. This was true despite the fact that almost 37% of patients reported being concerned about privacy after using the portal during that time.

Dr. Allison Weathers, Rush associate chief medical information officer, told the site that having access to the notes can help individuals with complex health needs and under the care of multiple providers. “Research shows that when patients can access their physicians’ notes, they better understand the medical issues and treatment plan as active partners in their care,” she said. “When a patient is sick, tired or stressed during a doctor’s visit, they may forget what the doctors said or prescribed.”

I think it’s also apparent that giving patients access to clinician notes helps them engage further with the process of care. Ordinarily, for many patients, medical notes from their doctor are just something that they hand along to another doctor. However, when they have easy access to their notes, alongside of the test results, appointment scheduling, physician email access and other portal functions, it helps them become accustomed to wading through these reports.

Of course, some doctors still aren’t OpenNotes-friendly. It’s easy to see why. For many, the idea of such sharing private notes — and perhaps some unflattering conclusions — has been out of the question. Many have suggested that if patients read the notes, they can’t feel free to share their real opinion on matters of patient care and prognosis. But the growth of the OpenNotes program suggests to me that the effect of sharing notes has largely been beneficial, giving patients the opportunity not only to correct any factual mistakes but to better understand their provider’s perspective. As I see it, only good can come from this over the long run.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is sponsored by Samsung Business. All thoughts and opinions are my own.

Coming out of the CHIME CIO Forum, I had a chance to mix and mingle with hundreds of hospital CIOs. There was one major theme at the conference: security. If you asked these hospital CIOs what was keeping them up at night, I’m sure that almost every one of them would say security. They see it as a major challenge and the job is never done.

I had more than one CIO tell me that breaches of their healthcare system are going to happen. That’s why it’s extremely important to have a 2 prong security strategy in healthcare that includes both creating security barriers and also a mitigation and response strategy.

One of the most challenging pieces of security identified by these healthcare CIOs was the proliferation of endpoints. That includes the proliferation of devices including mobile devices and the increase in the number of users using these technologies. There was far less concern about the mobile devices since there are some really deeply embedded software and hardware security built into mobile devices like Samsung’s Knox which has made mobile device security a lot easier to implement. The same can’t be said for the number of people using these devices. One hospital CIO described it as 21,000 points of vulnerability when he talked about the 21,000 people who worked at his organization. Sadly, there’s no one software solution to prevent human error.

This is why we see so much investment in security awareness programs and breach detection. Your own staff are often your biggest vulnerability. Training them is a good start and can prevent some disasters, but the malware has gotten so sophisticated that it’s really impossible to completely stop. That’s why you need great software that can detect when a breach has occurred so you can deal with it quickly.

On the one hand, it’s one of the most exciting times to be in healthcare IT. We have so much more data available to us that we can use to improve care. However, with all that data and technology comes an increased need to make sure that data and technology is kept secure. The good news is that many hospital boards have woken up to this fact and are finally funding security efforts as a priority for their organization. Is your organization prepared?

Inside the world of data archival (Download this Free Data Archive Whitepaper for a deep dive into the subject), there are nearly as many different types of archives as there are vendors. Many of the existing archival solutions that have gained popularity with large healthcare organizations are ones that are also frequently utilized by other sectors and often claim to be able to “archive anything.”

This can be very appealing, as an organization going through a merger will often retire dozens or even hundreds of systems, some clinical, but most only tangentially related to the delivery of care. HR systems, general ledger financial systems, inventory management, time tracking, inventory tracking systems, and CRMs are just a few of the systems that might also be slated for the chopping block. The idea of retiring all of these into a single logical archival solution is very appealing, but this approach can be a dangerous one. The needs of healthcare organizations are not necessarily the same as the needs of other sectors.
To understand why some archival approaches are superior to others, it’s useful to visualize the way each of the solutions extract, store, and visualize data. The methodologies used typically trade fidelity (how well it preserves the original shape and precision of the data) for accessibility (how easy it is to get at the information you need), and they trade how easily the solution can archive disparate sources of data (such as archiving both an EMR and a time-tracking system) with, again, accessibility.

There are certainly other ways to judge an archival solution. For instance, an important factor may be whether or not the solution is hosted by the archival vendor on-premises or remotely. Some factors, such as the reliability of the system, service level agreements, or its overall licensing cost are big inputs into the equation as well, but those aren’t necessarily specific to the overall archival strategy utilized by the solution. There are also factors that are so critical, such as security and regulatory compliance, that deficiencies in these areas are deal-breakers. Now that we have the criteria with which to judge the solution, let’s delve into the specific archival strategies being used in the marketplace.

Raw Data Backups
A shockingly large number of organizations treat raw data backups of the various databases and file systems as their archival solution. There are some scenarios in which this may be good enough, such as when the source system is not so much being retired as it is being upgraded or otherwise still maintained. Another scenario might be when the data in question comes from systems so well known that the organization won’t have significant issues retrieving information when it becomes necessary. The greatest benefit to this approach is that acquiring the data is fairly trivial. Underlying data stores almost always offer easy built-in backup mechanisms. Indeed, the ability to back up data is a certification requirement for EMRs, as well as a HIPAA and HITECH legal requirement. This strategy also offers “perfect” data fidelity, as the data is in the raw, original format.
Once it actually comes time to access the “archived” data, however, the organization is forced to fully reverse engineer the underlying database schemas and file system encodings. This leads to mammoth costs and protracted timelines for even simple data visualization, and it’s a major undertaking to offer any kind of significant direct clinician or compliance access to data.

Another danger with raw database backups is that many clinical system vendors have language in their licensing related to the “reverse engineering” of their products. So while it may be “your” data, the vendor may consider their schema intellectual property — and the act of deciphering it, not to mention keeping a copy of it after the licensing agreements with the system vendor have been terminated — may well be a direct violation of the original licensing agreement.

Hybrid Modeled / Extracted Schema
A common approach utilized by healthcare-specific archival solutions is to create a lightweight EMR and practice management schema that includes the most common data attributes from many different source system vendors and then map the data in the source system to this fully modeled schema. The mapping involved is usually limited to fieldtype mapping rather than dictionary mapping, although occasionally, dictionary data which feeds user interface aspects such as grouping (problem categories, for instance) may require some high-level mapping.

This approach usually yields excellent clinical accessibility because the vendor can create highly focused clinical workflows just like an EMR vendor can. Since these visualizations don’t need to be created or altered based on the source system being archived, it means that there is generally no data visualization implementation cost.
As the mapping is limited to the schema, the extraction and load phase is usually not as expensive as a full EMR data migration, but because every required source field must have a place in the target archival schema, the process is typically more time-consuming and expensive than the hybrid modeled / extracted schema or non-discrete document approaches. That said, vendors that have a solid library of extraction processes for various source systems can often offer lower initial implementation costs than would otherwise be possible.

The compliance accessibility and data fidelity of this strategy can be problematic, however, as unknown fields are often dropped and data types are frequently normalized. This fundamentally alters a substantial portion of the data being archived in the same way that a full data migration can — although, again, not as severely given the typical lack of data dictionary mapping requirements. In some cases, vendors will recommend that a full backup of the original data be kept in addition to the “live” archive, providing some level of data fidelity problem mitigation. Should a compliance request require this information, however, the organization may be left in a similar position to those utilizing raw data backups or extracted schema stores with no pre-built visualizations.

Archival solutions utilizing this strategy may also frequently require augmentation by the vendor as new sources of data are encountered. This can make the implementation phase longer, as those changes typically need to happen before any data can be loaded.

Summary
There will never be a one-size-fits-all archival solution across organizations, and even within an organization, when determining the strategy for multiple systems. Another key takeaway is to always be wary of all the “phases of implementation.” Many vendors will attempt to win deals with quick and inexpensive initial implementations, but they leave significant work for when the data actually needs to be visualized in a meaningful way. That task either falls on the organization, or it must be further contracted with the archival solution provider.

It also is valuable to consider solutions specifically designed for archival purposes and, ideally, one that focuses on the healthcare sector. There are simply too many archival-specific scenarios to utilize a general purpose data backup, and many organizations find that the healthcare-specific requirements make general purpose archival products ill-suited for their needs.

About Robert DowneyRobert is Vice President, Product Development,atGalen Healthcare Solutions. He has nearly 10 years of healthcare IT experience and over 20 years in Software Engineering. Robert is responsible for design and development of Galen’s products and supporting technology, including the VitalCenter Online Archival solution. He is an expert in healthcare IT and software development, as well as cloud based solutions delivery. Connect with Robert on LinkedIn.

About Galen Healthcare SolutionsGalen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of theTackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us onTwitter,FacebookandLinkedIn.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study has concluded that while they obviously have other goals, an overwhelming majority of healthcare CIOs see data protection as their key objective for the near future. The study, which was sponsored by Spok and administered by CHIME, more than 100 IT leaders were polled on their perspective on communications and healthcare.

In addition to underscoring the importance of data security efforts, the study also highlighted the extent to which CIOs are being asked to add new functions and wear new hats (notably patient satisfaction management).

Goals and investments
When asked what business goals they expected to be focused on for the next 18 months, the top goal of 12 possible options was “strengthening data security,” which was chosen by 81%. “Increasing patient satisfaction” followed relatively closely at 70%, and “improving physician satisfaction” was selected by 65% of respondents.

When asked which factors were most important in making investments in communications-related technologies for their hospital, the top factor of 11 possible options was “best meets clinician/organizational needs” with 82% selecting that choice, followed by “ease of use for end users (e.g. physician/nurse) at 80% and “ability to integrate with current systems (e.g. EHR) at 75%.

When it came to worfklows they hoped to support with better tools, “care coordination for treatment planning” was the clear leader, chosen by 67% of respondents, followed by patient discharge (48%), “patient handoffs within hospital” (46%) and “patient handoffs between health services and facilities” chosen by 40% of respondents selected.

Mobile developments
Turning to mobile, Spok asked healthcare CIOs which of nine technology use cases were driving the selection and deployment of mobile apps. The top choices, by far, were “secure messaging in communications among care team” at 84% and “EHR access/integrations” with 83%.

A significant number of respondents (68%) said they were currently in the process of rolling out a secure texting solution. Respondents said their biggest challenges in doing so were “physician adoption/stakeholder buy-in” at 60% and “technical setup and provisioning” at 40%. A substantial majority (78%) said they’d judge the success of their rollout by the rate the solution was adopted by by physicians.

Finally, when Spok asked the CIOs to take a look at the future and predict which issues will be most important to them three years from now, the top-rated choice was “patient centered care,” which was chosen by 29% of respondents,” “EHR integrations” and “business intelligence.”

A couple of surprises
While much of this is predictable, I was surprised by a couple things.

First, the study doesn’t seem to have been designed for statistical significance, it’s still worth noting that so many CIOs said improving patient satisfaction was one of their top three goals for the next 18 months. I’m not sure what they can do to achieve this end, but clearly they’re trying. (Exactly what steps they should take is a subject for another article.)

Also, I didn’t expect to see so many CIOs engaged in rolling out secure texting, partly because I would’ve expected such rollouts to already have been in place at this point, and partly because I assume that more CIOs would be more focused on higher-level mobile apps (such as EHR interfaces). I guess that while mobile clinical integration efforts are maturing, many healthcare facilities aren’t ready to take them on yet.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Typically, we cover US-based stories in this blog, but the following is just too intriguing to miss. According to a Vancouver newspaper, an area hospital system agreed to pay physicians a daily fee to use its unpopular Cerner EHR, positioning the payments as compensation for unpaid overtime spent learning the system.

The Times Colonist is reporting that local hospital system Island Health has offered on-call physicians at its Nanaimo Regional General Hospital $260 a day, and emergency department physicians up to $780 a day, to use its unpopular Cerner system.

The newspaper cites a memo from hospital chief medical officer and executive vice president Dr. Jeremy Etherington, which says that the payment was in recognition of “the extra burden the new electronic health record has placed on many physicians during the rollout phase” of the new EHR.

In 2013, Island Health (which is based in British Columbia, Canada) signed a 10 year, $50 million deal with Cerner to implement its platform across its three hospitals. More recently, in March of this year, Island Health’s three facilities went live on the Cerner platform.

Within weeks, physicians at Nanaimo Regional Hospital were flooding executives with complaints about the new platform, which they claimed we randomly lost, buried or changed orders for drugs and diagnostic tests. Some physicians at the hospital reverted to using pen and paper to complete orders.

Not long after, physicians signed a petition asking the health system to stop further implementation, citing safety and workability concerns, but executives still moved forward with the rollout.

Neither the newspaper article nor other reports could identify how many physicians accepted the offer from Island Health. Also, the health systems management hasn’t shared how it picked doctors who were eligible for the payout, and what criteria it used to determine the size of the higher emergency department physician payouts. However, according to a Nanaimo physician and medical staff member quoted by Becker’s Health IT & CIO Review quotes, execs structured the payments to reflect the unpaid overtime doctors put in to learn the system.

As for the claims that the Cerner system was causing clinical problems and even perhaps endangering patients, that issue is still seemingly unresolved. In late July, British Columbia Minister of Health Terry Lake apparently ordered a review of the Cerner system, but results of that review do not appear to be available just yet.

It’s not clear whether the payments bought Island Health enough goodwill to mollify the bad feelings of doctors who didn’t receive one of these payments, nor whether those who are being paid will stay bought. And that’s the real question here. Call the payments a publicity stunt, an attempt at fairness or cynical political strategy, they may not be enough to get physicians onto the system if they are convinced it doesn’t work. I guess we’ll have to wait and see what happens.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When social media initially started to become popular, a man named Ed Bennet did this amazing job creating a list of hospitals that were doing things on social media (ie. Facebook and Twitter). It was a really incredible look into how hospitals were approaching Twitter and Facebook. At the time, no one knew what they were doing. We were all trying to figure out. It was a dynamic and fun time, but also a bit scary since we were all shooting from the hip.

Over time, most hospitals have adopted a full social media strategy and have professionals that are quite familiar with the options available. Certainly, there are some that execute their hospital social media strategy better than others, but very few hospitals aren’t active in some way on social media.

In typical Ed fashion, he’s moved on from social media and has now created a Physician Transparency List which highlights the ways hospitals are displaying various physician ratings on their hospital website. I love that he calls it a transparency list since so many organizations are afraid of these physician ratings. So, it takes a bit of bravery to be willing to post the ratings on your hospital website.

So far Ed has 35 hospitals on that list, but I believe over the next 3-4 years we’ll see most hospitals doing some form of physician transparency on their hospital website. It very much feels like social media where it started with a few hospitals and then spread to many more.

The reality is that these physician ratings are going to be available to the public. So, why not put them on your hospital website? At least then you control the experience the user has and you can give them the opportunity to engage with you and your organization. In fact, I think that’s where so many hospitals have done a poor job. It’s one thing to display a rating. It’s a whole other thing to create easy opportunities for patients viewing your physicians’ ratings to engage with your organization. It’s such a missed opportunity for most hospitals.

I look forward to seeing Ed’s list continue to grow. Plus, it will be great to see how hospitals are taking advantage of this opportunity to be transparent and engage with patients.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

When your organization decides to convert to a new EMR, the problems it faces extend beyond having to put the right technical architecture in place. Deciding which data to migrate and how much data to migrate from the previous EMR poses additional challenges, and they’re not trivial.

On the one hand, moving over all of your data is expensive (and probably not necessary). On the other, if you migrate too little data, clinicians won’t have an adequate patient history to work from, and what’s more, may not be in compliance with legal requirements.

But there are methods for determining how to make the transition successfully. HCI Group Data Technical Lead Mustafa Raja, argues that there are three key factors hospitals should consider when planning to migrate legacy EMR data into a new system:

Decide which data you will archive and which you will migrate. While many organizations fall back on moving six months of acute care data and a year’s worth of ambulatory data, Raja recommends looking deeper. Specifically, while ambulatory transitions may just include medications the patients are on and diagnostic codes in the past year, acute care data encompasses many different data types, including allergies, medications, orders, labs and radiology reports. So deciding what should transition isn’t a one-size-fits-all decision. Once you’ve made the decision as to what data will be transitioned, see that whatever archival storage system you decide upon is easily accessible and not too costly, Raja suggests. You’ll want to have the data available, in part, to respond to security audits.

Consider how complex the data is before you choose it for transition to the new EMR. Bear in mind that data types will vary, and that storage methods within the new system may vary from the old. If you are migrating from a nonstandard legacy system to an EMR with data standards in place — which is often the case — you’ll need to decide whether you are willing to go through the standardization process to make the old data available. If not, bear in mind that the nonstandard data won’t be easily accessible or usable, which can generate headaches.

Be prepared for the effect of changes in clinical rules and workflow. When upgrading from your legacy system, you’ll probably find that some of its functionality doesn’t work well with the new system, as the new system’s better-optimized workflows will be compatible with the old system, Raja notes. What kind of problems will you encounter? Raja offers the example of a legacy system which includes non-required fields in one of its forms, transitioning to a system that DOES require the fields. Since the data for the newly-required fields doesn’t exist, how do you handle the problem?

Of course, your plans for data migration will be governed by many other considerations, including the speed at which you have to transition, the purposes to which you plan to put your new EMR, your budget, staffing levels and more. But these guidelines should offer a useful look at how to begin thinking about the data migration process.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

New York-based Mount Sinai Hospital has begun a project which puts it in the vanguard of predictive analytics, working with a partner focused on artificial intelligence. Mount Sinai plans to use the Cloud Medx Clinical AI Platform to predict which patients might develop congestive heart failure and care better for those who’ve already done so.

As many readers will know, CHF is a dangerous chronic condition, but it can be managed with drugs, proper diet and exercise, plus measurement of blood pressure and respiratory function by remote monitoring devices. And of course, hospitals can mine their EMR for other clinical clues, as well as rifling through data from implantable medical devices or health tracking bands or smartwatches, to see if a patient’s condition is going south.

But using AI can give a hospital a more in-depth look at patterns that might not be visible to the unaided clinician. In fact, CloudMedx is already helping Sacramento-based Sutter Physician Services improve its patient care by digging out unseen patterns in patient data.

To perform its calculations, CloudMedx runs massive databases on public clouds such as Amazon Web Services and Microsoft Azure, then layers its specialized analytics and algorithms on top of the data, allowing physicians or researchers to query the database. The analytics tools use natural language processing and machine learning to track patients over time and derive real-time clinical insights.

In this case, the query tools let clinicians determine which patients are at risk of developing CHF or seeing their CHF status deteriorate. Factors the system evaluates include medical notes, a patient’s family history, demographics and past medical procedures, which are rolled up into a patient risk score.

In moving ahead with this strategy, Mount Sinai is rolling out what is likely to be a common strategy in the future. Going forward, expect to see other providers engage the growing number of AI-based healthcare analytics vendors, many of whom seem to have significant momentum.

Risk Matrix bases its predictions on its customers’ datasets, including labs, EHR data claims information and other types of data organized using FHIR. Once data is mapped out into FHIR, Risk Matrix generates output for more than 1 million records in less than three hours, the company reports. Users access Risk Matrix analyses using a FHIR-compatible API, which in turn allows for the results to be integrated into the output of the existing workflows.

While many startups have flocked into the imaging and diagnostics space, expect to see AI-related activity in drug discovery, remote monitoring and oncology. Also, market watchers say companies founded to do AI work outside of healthcare see many opportunities there as well.

Now, at least at this stage, high-end AI tools are likely to be beyond the budget of mid-sized to small community hospitals. Nonetheless, they’re likely to be deployed far more often as value-based reimbursement hits the scene, so they might end up in use at your hospital after all.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Particularly as value-based reimbursement falls into place, hospitals have good reasons to track emergency department utilization across populations. As with readmissions, ED visit rates and diagnoses can tell you something valuable about patients’ conditions and the extent to which they are managing those conditions, as well.

However, tracking individual ED use, especially by behavioral health patients, may result in less-desirable consequences. In fact, according to a viewpoint article published recently in JAMA, adding icons or symbols to the records of patients who are considered to be “superusers” or “frequent fliers” can stigmatize patients and create bias against them.

“A pejorative branding, ‘frequent flyers’ are often assumed to be problem patients. In psychiatric settings, these patients are sometimes said to be ‘borderlines,’ ‘drug seekers,’ ‘malingerers,’ or ‘treatment resistant,’ according to authors Michelle Joy, MD, Timothy Clement, MPH and Dominic Sisti, PhD.

The researchers note that at least one EMR offers the capacity to insert an airplane icon beside the patient’s name, and not only that, to display the icon in different colors depending on where the patient falls among the high using population. But they consider this to be ethically and clinically inappropriate.

For one thing, they say, uses such an icon ‘encourages the use of disrespectful and stigmatizing terminology.’ What’s more, the use of such labels may change the clinician’s initial interactions with the patient in a way that affects their judgment negatively, and may subject the patient to the risk of a poor outcome from their care.

Not only that, they point out, while it might be useful to know that a patient presents in the ED frequently, determining why this happens can only take place if the clinician does a deeper dive into their utilization history. And slapping a high utilization icon the patient record actually discourages such in-depth examination, they contend.

On top of all that, if the patient is assumed to be visiting the ED frequently for largely psychiatric reasons, “diagnostic overshadowing” may occur, to the patient’s detriment. For example, they note, if a patient has a co-occurring mental illness in a condition such as cardiovascular disease, the patient is less likely to receive adequate medical care than patients without a medical condition, as the psych diagnosis overshadows their medical problems.

To avoid creating signifiers like the icon, which may build in the makers’ implicit biases, EMRs and behavioral health apps should be filled and tested in collaboration with patients, consumers, ethicists and other parties sensitive to the broader ramifications of using such language and iconography, the authors suggest.

In the meantime, readers of this publication might want to stop and think if there are any other ways in which the health IT systems they design and use reflect other unhelpful biases. While placing a frequent flyer icon beside a patient’s name seem like a particularly egregious instance — or does to me anyway – there may be subtler ways in which your HIT systems foster negative or inappropriate assumptions. And it’s good to dig those out and examine them. After all, nobody wins when patients fail to get the care they need.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After spending time with so many HIM professionals at the AHIMA Annual conference, I’ve come back thinking about the future of medical coders. No doubt, many HIM professionals are moving well beyond medical coding into other areas such as healthcare analytics, clinical documentation improvement (CDI), EHR optimization, and much more. However, there’s still a massive need for high quality medical coding and the HIM professionals that provide that service.

As we look into the future, the techie in me feels like medical coding should be automated. Why are we paying people to do medical coding? Why can’t that be automated and be done by robots? It’s not like medical coding is a particularly fun job. I’m sure there are some times it’s fun working on unique cases, but it can be quite monotonous and tedious. Why not have a computer do it instead?

What I’ve learned over the years is that medical coding is more art than it is science. Certainly there are some clear cut cases where it’s basically science. However, a large part of what a coder does isn’t set in stone. There’s some artistic licence if you will, or at least some interpretation that has to happen in order to code a visit properly. Computers aren’t good at interpretation, but humans are.

The other reality is that doctors don’t produce perfect documentation. If they did, then we probably could code a robot to code a patient visit. Since there are nuances to every physician’s documentation, we’re going to need humans that interpret those nuances as part of the coding process. I don’t see this changing in our lifetimes.

One word of caution. Many people fall into the trap that we need automated robot coding to be perfect for it to accepted. That’s just not the case, because human coders aren’t perfect either. In fact, there’s some research that human coders aren’t as good as we thought they were at coding, but I digress. The reality is that automated coding just has to be better than humans, it doesn’t have to be perfect. Even with this said, I don’t see it happening for a while.

What we do see happening now is a collaboration between humans and computers: computer assisted coding. While we don’t have to worry about computers replacing humans in medical coding, we do need to focus on ways that technology can make the work humans do better. That’s a powerful concept that we’re starting to see happen already.